When Exception to Policy Is Exceptional Policy: How Booking Physical Therapy Appointments Too Far in the Future May Adversely Impact Access to Care, Business Optimization, and Readiness.

INTRODUCTION: Physical therapy (PT) is a high-volume service that treats musculoskeletal injury and improves return-to-duty rates. Our experience suggests that no-show (NS) and patient cancellation (PC) rates increase the further appointment that is booked in the future, impede access to care, and increase the healthcare delivery costs. The article's purpose is to examine PT National Capitol Region (NCR) appointment data to inform appointment policies. METHODS: We utilized one year of retrospective Military Health System Management and Reporting Tool and Composite Health Care System Ad Hoc Data Pulls to review NCR PT appointment data to evaluate the effect of timing on NS and PC rates. RESULTS: We analyzed 797 new appointments at Walter Reed National Military Medical Center. Data revealed that 16% of patients seen within 10 days NS or PC; 22% of patients seen between 11 and 20 days NS or PC; 28% of patients seen 21 to 30 days NS or PC; and 25% of patients seen over 30 days after consultation NS or PC. We analyzed 182,134 PT appointments (all types) in the NCR. The NS rate was 11.1% (range 8.4-14.9%). CONCLUSIONS: At Walter Reed National Military Medical Center, 17% of new appointments were lost when they were booked over 20 days in advance; additionally, NS and PC rates were greatest after 20 days from consultation.